Comparison of Health Status and Quality of Life of Related Versus Paid Unrelated Living Kidney Donors

Abstract

The aim of this cross-sectional study was to assess the health status and quality of life (QOL) of paid unrelated versus related living kidney donors postdonation at Shiraz Transplant Center in Iran. We invited all donors (n ¼ 580, 347 paid unrelated, 233 related) who underwent donor nephrectomy at our center from 2004 to 2010 to participate in a health survey and physical examination. Of 580 donors, 144 consented to participate; participation of paid unrelated donors was significantly lower than related (52/347 vs. 92/233; p < 0.001). Participants underwent a complete physical examination, QOL assessment (using a 36-item short form health survey [SF-36] questionnaire) and laboratory work-up. The paid unrelated donors compared with related donors were younger (34.2 AE 7.2 vs. 40.7 AE 9.7 years, p < 0.001), had shorter time since donation (2.9 AE 1.6 vs. 3.8 AE 2 years, p ¼ 0.004), had higher estimated GFR (72.6 AE 22 vs. 63.8 AE 15.3 mL/min/ 1.73 m 2 , p¼ 0.006) and had a higher percentage of patients with microalbuminuria (35% vs. 0%, p < 0.001). Additionally, general health and social functioning scores among paid unrelated donors were significantly lower (p < 0.001 and p ¼ 0.02, respectively) than related donors. Other SF-36 scores, although lower in paid unrelated donors, did not reach statistical significance. Iranian paid unrelated donors have lower QOL and higher incidence of microalbuminuria compared with related donors.

Quality and Quantity of Health Evaluation and the Follow-up of Iranian Living Donors

“…There are few limited reports from single centers that describe only 1 or 2 aspects of the consequences of living donation [20,21]. This ignorance may be mainly due to lack of any system for living donation.…”

“…Fallahzadeh also showed that the general health of donors and their remaining kidney function in paid unrelated donors are inferior in comparison with related living donors [21].…”

Challenges and Future Recommendation for Kidney Transplantation in Iran: A Narrative Review

“…(3) Living Unrelated kidney donation (LURD). Due to the long-waiting list of patients seeking organ transplant, the Iranian kidney transplant model has been at the center of attention (13). Iran has the shortest waiting list for kidney transplants in the world, while the United States as well as European countries have a very long waiting list (14).…”

Technology- and Policy-Based Strategies for Increasing Supply of Deceased Donor Livers

“…Additionally, we view such incentives as ethically problematic, because the direct involvement of money (other than reimbursement of donor costs, below) commodifies the human body and creates vulnerability to exploitation. Iran provides a stipend to living kidney donors (approximately $400) and one year of free medical insurance [35]. Controversially, the Iranian government permits the exchange of money between organ recipients and their donor candidates (even providing a "private space" where these negotiations can take place) [36].…”